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MAR 2 9ERVSTA-CL NWINTER CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) sia�2DD" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(iss) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Geor a Petersen Insurance Agency, Inc. g P.O. Box 3539 Santa Rosa, CA 95402 CONTACT NAME: _ PHONE yr FK Ai 707 525-4150 H 707 525-4175 !_c. N9 Fit) . _ (! _�_...�.._.____—_ E-MAIL ..,ADDRESS: Info ins.com AFFORDING, COVERAGE NAIC,k_ INSURER A: Insurance Company of the West 2784_7_ INSURED INSURER B:_' - INSURER C`-'-- Service Station Systems, Inc. INSURER 3224 Regional Parkway Santa Rosa, CA 95403 _D:._ _ INSURER E: INSURER F: _----j- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN.gk................ LTR _ - TYPE OF INSURANCE IINS D WV -- -- -- POLICY NUMBER P ICY EFF MMfDOM'W P LICY EXP MMIDDNYYY '—� LIMIT -� UNITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE CD OCCUR- EACH OCCURRENCE $ T5i4MAGE TO RENTED— PREMISES (Ea occurrence $ MED EXP (Anyone person) s PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: - _ PO�UCYpE 0 C� LOC OTHER: GENERAL AGGREGATE $ PRODUCTS-COMPIOP A $ - _----j- j AUTOMOBILE LIABILITY ANY AUTO ALL OWNED '- SCHEDULED AUTOS AUTOS NON-OWNEO _ HIRED AUTOS AUTOS I - EO acc EDlSINGLE LIMIT $ BODILY INJURY (Per person) S. BODILY INJURY (Per accident) $ POPOR—TY DA MA -E $�' Per accident $ UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ _ _ AGGREGATE $ DED RETENTION$ _ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERlEXECUTNE OFFICERIMEMBER EXCWDE07 ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WPL502130703 08IM015 06/04/201e _ PER TH- _X STATUTE ER _ E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE .. POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, AddlOonal Remarks Schedule, may be attached N mon opaoa,Wrequired) 'Proof of Coverage` 911.7 tE7J 17119 Alt] 3:1 Insured's Copy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUT H ORIZED (REPRESENTATIVE 0 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD